Today's Veterinary Practice

JUL-AUG 2017

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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14 INSIDE NAVC INSIDE NAVC HOW IS TELEHEALTH BEING USED? Professional Use of Telehealth If you're texting a client to see how Fluffy is doing or answering a question about medication side effects, you're using telemedicine. If you're monitoring an animal remotely, even if it is in the clinic and you are watching vital signs from another computer, you're using telemedicine. Clients often want more advice than Dr. Google can give, but don't have the time or finances to see a veterinarian, so they use telehealth providers to answer questions through text or online services. Because the providers are aware of the VCPR legislation, most neither prescribe nor diagnose online. We have all heard of companies or veterinarians who use secret forums, like those found on Facebook, to diagnose and prescribe. VIC condemns the use of telehealth tools when it is inappropriate and violates state legislation. We favor promoting the judicious use of these tools to extend more healthcare to more animals. Examples are emails, texts, instant messages, phone calls, sending of photos and videos, and live videos. Appropriate Use of Telehealth Tools The telehealth scenarios that we see most frequently and those with the greatest success are the following: • Postoperative follow-up • Dermatologic concerns • Behavioral issues/training • Transportation issues • Hospice care • Basic triage (whether the pet should be seen by the veterinarian) • Environmental concerns/hazards that might contribute to a particular condition • Long-term care monitoring For these scenarios, telehealth tools provide sufficient information to assist pet owners without the necessity of a hands-on physical examination. In some cases, the tools are insufficient and an in-person exam is required; in those instances, veterinarians are discounting the in-person visit according to the cost already paid for the telehealth service. Three models are effective: • No-charge first exam • Often results in need for in-person visit (anecdotally, people who connect through telehealth first tend to visit 50% more and sooner and spend 20% more in person) • Additional feature of a pre-existing wellness package • No charge (or charge included in package) • Convenience for client • Per-usage charge • By-the-minute or usage charge • If in-person exam still required, costs credited to client's account Getting Started The most effective way of getting started with telehealth is to follow the "lean startup" method: Start with 1 or 2 low-risk cases and 1 or 2 doctors and clients. Learn what is successful and measure the outcomes. Slowly expand to include another doctor, another client, and another use case. Then measure and repeat. An example of this is using a text service to inform clients of negative fecal results. Slowly add more use cases and clients until you can diagnose and prescribe within the confines of your state legislation. Using Telehealth Within State Legislation All states except Connecticut (as well as the District of Columbia) forbid diagnosis and prescription without a valid VCPR that is established through an in-person exam. As was found in human healthcare, this legislation might be challenged in court because of its antitrust properties. Whether company- or client-driven, there are many examples of legislation crumbling under consumer pressure. A protectionist strategy of reinforcing legislation that goes against client demands is never a good approach. Veterinarians who are gaining an understanding of and comfort level with telehealth will be in a better position to use telehealth tools appropriately as pet owner demand increases. Veterinarians must be allowed to exercise their best judgment regarding when telehealth tools should be used and when they should not. If the veterinarian does not feel that sufficient information can be gathered through remote, electronic means, then those tools should not be used. However, if veterinarians can gather enough information from remote digital tools, then they should use these tools as long as doing so is in the animal's best interest. The VIC, the American Veterinary Medicine

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